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Biologic Treatments for Asthma

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Many people who live with asthma manage their symptoms by identifying and avoiding triggers, taking daily oral and inhaled medications, and using a quick-relief inhaler. Recently, many new drugs known as biologics have been approved for treating moderate-to-severe asthma. Biologic therapies are antibodies (immune proteins) that target specific molecules that contribute to poorly controlled asthma.

There are many new biologic therapy options available to treat severe asthma. They work by disrupting the pathways that lead to inflammation in the body that causes asthma symptoms. Xolair and Nucala are approved for patients as young as six years old, while Dupixent and Fasenra are approved for patients as young as 12 years old. Cinqair is approved for adults 18 years and over. 

Biologic therapy may not work for everyone and it may require the use of other treatments as well, but the vast majority of patients on biologic therapy have significant improvement in their asthma symptoms and also require far less if any oral steroids. It is important to see an asthma specialist in order to learn if biologic treatment is right for you. Our experts at AAFAC can help you identify what triggers your asthma and find the treatment that is unique to you and your needs.

 

Source: verywellhealth.com/biologics-for-severe-asthma-4788216

 

What are USP 797 Guidelines?

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Our practice is compliant with USP 797 guidelines – what does that mean, and what is USP?

In the early 1800s, when people needed medicine, they went to their local apothecary, where the druggist would mix together a medical preparation derived from hand-collected plants and minerals. But the potential consequences of inconsistent or poor-quality medicinal ingredients or a mistake by the person behind the counter could be serious. Two hundred years ago, the types and quantities of the drug ingredients varied widely. Patients were sometimes given too little or too much. There were often multiple names for the same medicine, and medicines with the same name didn’t always share the same properties. Medical professionals did their best, but in some instances, the treatment could be more dangerous than the ailment. 

In the years following the American Revolution, as poverty increased and America’s water and air became more polluted, people grew sicker. Mainstream medicine became increasingly ineffective. Americans began to seek out non-conventional medicine and people who embraced these methods. Tensions grew between trained doctors and the American public looking for more effective cures. This growing distrust of traditional medicine was one factor that drove one of the most groundbreaking periods for medical inventions in the 19th century, along with the development of modern medicine in general.

Rising from this tension, Lyman Spalding, a physician and professor from New York, became alarmed when he observed inconsistent and poor-quality medicines threatening the health of his patients. He, with the help of Samuel Mitchill, an American physician, naturalist, and politician from New York, convinced other physicians to meet in January 1820 at the United States Capitol to form the United States Pharmacopeia (USP). They put in place standards for the quality of medicines that would protect the public’s health. Reflecting the spirit of the young nation, the group would not be part of the government but instead would remain an independent organization that relied on the latest science to build trust in medicines. 

They created a well-defined and clearly described roster of the best understood medicinal substances and preparations of the day that could be used by medical professionals across the newly established United States of America to prepare medicines consistently and to establish independence from Britain. This first edition of the U.S. Pharmacopeia was written in both English and Latin, making it broadly accessible, and was printed at a low cost to make it easily affordable. 

Move forward almost 100 years.  In 1911 immunotherapy for grass pollen-induced hay fever was used by collecting grass pollen, creating an extract, and injecting it into patients.  Over the ensuing decades, companies took on the role of collecting and purifying pollens and other allergens and making them available to Allergists in practice worldwide.  Most Allergists used these commercial materials to compound allergy extracts to administer to their patients, although there was often a lack of agreement on what and how much to use for treatment.  

Fast forward to today and the modern practice of Allergy.  The USP has regularly met and revised guidelines and recently has established a set of standards that apply to the practice of Allergy and compounding of allergy extracts used in allergen immunotherapy.  

The current USP Chapter 797 provides standards unique to allergen extract compounding for individual patients.  Under the new standards, to continue in-office compounding of individual treatment for allergen immunotherapy, allergy practices need to comply with personnel qualifications, facilities requirements, and documentation.  

How has Allergy Asthma & Food Allergy Centers addressed and met these requirements? 

  • Our allergen extract mixing is overseen by Dr. Michael Borts who has over 30 years of experience in allergen extract compounding.  
  • Our Clinical Staff, Ashley Crowden, RN and Jessica Tharp, RN have completed training and standardized testing on principles and procedures for sterile compounding, garbing, hygiene, gloved fingertip, and thumb sampling and media fill tests.
  • Our compounding occurs in a dedicated Allergenic Extracts Compounding Area located in our South County office location. 
  • Our allergen extracts are labeled with patient name, type, and fractional dilution with corresponding vial number, beyond use date, and required storage conditions.
  • Training, assessment results, evaluations, and qualification records for all compounding personnel, including any corrective actions following assessments and evaluations are kept on file. 

In addition, we use Rosch Immunotherapy in order to provide additional efficiency and safety with rapid patient check-in (to reduce pre-injection waiting times), bar-coding of vials (to promote patient safety with the right extract for the right patient), and efficient documentation of injections.  

While the lack of any reported cases of an infectious adverse event might make these guidelines seem unnecessary, our practice is willing to comply with the USP Expert Compounding Committee’s guidelines to reflect our dedication to patient safety.

 

Q & A with Lauren Davis PA-C

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Q: What inspired you to become a Physician Assistant in the field of allergies, asthma, and immunodeficiencies?

A: Actually, I came across this specialty by accident. My physician assistant program provided a general education across a variety of specialties. I knew I wanted a career where I had an opportunity to work with children. I got really lucky to find this specialty (and this office). Not only do I get to treat children, but I get to treat families. I really enjoy getting to see patients frequently, and I feel that our work makes a difference in allowing kids and adults to live more normal lives.

Q: What do you love most about your job?

A: I love the opportunity to see people over and over again. It allows me to form relationships with the families and to get insight into how they are truly doing. I really like being there for milestones for families. Whether that is watching them eat their first peanut, or getting them through a winter without terrible asthma exacerbations, I like being there for these families and doing things to improve their quality of life.

Q: What are your hobbies outside of work?

A: Anything outside! I love playing tennis, skiing, and hiking. I can’t wait for the nicer weather.

Personalized & Caring Approach to Phlebotomy

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To identify what airborne allergens or food substances you are allergic to, we generally perform a prick skin test. Allergy testing can be done by a blood test, or phlebotomy, as well. While in some cases, skin testing can identify an allergy that is missed by blood testing, the latter can be useful for evaluating and managing food allergies. Skin testing allows us to obtain results and to develop a treatment plan at the time of your visit, but sometimes it may be helpful to prepare children for blood testing as well, especially if food allergy is a concern. Our phlebotomist, Emily Alexander, is wonderful and takes a personalized and caring approach to her patients.

Emily shares her story below:

I started my lab career at the age of 18 as a lab assistant, learning all the ins and outs of how a laboratory works. My mom had previously worked in that same lab, so it was easy for me to get started on the right foot from coworkers that knew of me. My interest was piqued at a young age, I got to ask a lot of questions about why and how a lab works. Microscopes, tubes, beakers, needles, and the importance to remember that behind each tube being a person.  

My next step was learning phlebotomy from a team of people that instilled the motto of “lab work is the gateway of going home.” Treating each child as if they were our own and the importance of collecting lab tests properly. That journey started in 2007 at a high-ranking local pediatric hospital where the patients and co-workers treated each other as family. The understanding that patients could be scared and apprehensive when I walk into the room was not to be taken lightly. The parents are often nervous and children can sense it and feed off of it. Taking a caring and gentle approach to each baby, toddler, child, and teenager means as much to the patient and parents as it does to me.   

After years of building trust and confidence with families and their physicians (and getting their sometimes complex laboratory orders completed) is how I met the providers, Dr. Warrier, Dr. Borts, and Dr. Vitale. 

I switched gears to private practice in 2016 at Allergy Asthma & Food Allergy Centers, and I continue to take pride in comforting a wide range of ages from babies to adults. I listen to their concerns and their previous experiences. Children like to hear that everyone gets their blood collected at one point in their life and that they’ll be okay before/after the labs are collected.

Whether the families have driven for hours or minutes to get lab work done, I like for them to feel at ease with me. When it comes down to the actual process of blood collection, it’s always best and helpful for the patient to be hydrated and to try to keep from drinking sodas or anything with caffeine. I use a comforting tone while I speak to the children while making eye contact. I like to give the children my honest step-by-step instructions of how it’ll be done and with a few countdowns of 1-2-3’s so there aren’t any surprises. 

One thing I make sure to do is always put the tourniquet on top of the sleeve and not too tight to cause much discomfort or possible pinching. With that being done at the beginning, I believe that it sets the stage for a more peaceful collection. I always ask how they’re doing and love having conversations about their favorite things, like activities, games, shows, or whatever is on their mind. These hidden gems are the best part of my day. Keeping their minds off of whatever is happening has a great calming effect. 

As parents, we don’t ever want to feel like we’re putting our kids in scary situations. Blood draws can be hard on parents, so be mindful of that. Your little ones feel your energy. For them, manage your fear, anxiety, or apprehension as best you can. I would refrain from telling your child too far ahead of time that it will hurt or making a big deal of it. For some families, it may be helpful that the less nervous parent or caregiver is with the child during this appointment. When the patients and families leave with a smile on their faces and the peace of mind of having accurate results, I’ve done my job.

 

Meet Our Team: Dani Loftus

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We are pleased to introduce you to Dani Loftus! She is a Certified Family Nurse Practitioner (FNP-BC) & Certified Pediatric Nurse (CPN) who treats people of all ages at the Allergy, Asthma & Food Allergy Centers (AAFAC). Learn more about her in the Q&A below:

Q: How long have you worked at AAFA centers?

A: I joined AAFAC in November 2019. This is my first position after graduating with my Doctor of Nursing Practice (DNP) Degree in May 2019. Prior to joining AAFAC, I worked at St. Louis Children’s Hospital, Shriners Hospitals for Children, and Southern Illinois University Edwardsville.

Q: What inspired you to be a nurse practitioner? 

A: I was inspired to become a nurse from growing up taking care of my grandmother who had diabetes. She was an inspiration and I miss her dearly. 

I wanted to become a nurse practitioner after experiencing the health care system from the perspective of the patient. In 2014 I had two tumors removed from my tongue, and I was hospitalized twice. I had to relearn to eat and how to talk. It was through that experience that I wanted to become a nurse practitioner. I chose to pursue my education through SIUE as I had excellent experiences attending the school for both my bachelor’s and master’s degrees.

Q: What do you love most about your job?

A: I love that I am in an environment where I can continue to learn something new every day. I enjoy working with a physician team that is passionate about teaching!

Q: What are your hobbies outside of work?

A: Outside of work, I spend a lot of time with my family and our rescue pets. I enjoy playing board games and exploring new places. Travel is a passion of mine, and I have been fortunate to see many beautiful places including the Eiffel Tower and the Great Wall of China!

 

COVID-19 Vaccine

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We have received numerous questions over the past several weeks regarding the Covid vaccines, and we will try to address most of them in this post. We have compiled this information from different sources which are listed at the end of this piece. Please note, the Pfizer and Moderna COVID-19 vaccines are some of the safest and most effective vaccines for an infectious disease. These vaccines will end this pandemic if almost every human around the world is inoculated.

 

Will our practice (Allergy, Asthma & Food Allergy Centers) receive vaccines to immunize our patients?

As of 4/28/21, we will NOT as the mRNA approved vaccines require extremely cold temperatures (-70°C or -94°F for Pfizer; -20°C or -4°F for Moderna) for storage, and there is now good access for the general population (except most kids) to receive all 3 approved vaccines.

 

I have allergies (to foods, drugs, pollens, etc.). Am I at risk for a severe allergic reaction to the vaccine?

If you have an allergy to polyethylene glycol or some injectable medications, you may be at risk, but food allergies, drug allergies to oral medications, and environmental allergies do not put you at any significant risk over the general population. You will also be monitored for at least 15-30 minutes after vaccination, and vaccination sites should have epinephrine on hand on the off chance you have a reaction. Remember, no one has died from Covid vaccination despite millions of doses and as of this post, over 400,000 people have died due to COVID in the US.

There was a recent CDC  report with 71% of anaphylaxis cases being in the first 15 min. Anyone with an anaphylactic history can and should wait 30 mins. 

There is currently no validated testing for suspected allergy to polyethylene glycol or for other components of the vaccine. You can find more information here: American College of Allergy, Asthma & Immunology (ACAAI) Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines.

Remember, allergic reactions to the vaccine are relatively infrequent; roughly one in every hundred thousand injections — more than 100 times less common than allergic reactions to penicillin. Reactions are being observed because so many people are being immunized. Importantly, everyone who has had a reaction has been effectively treated and stabilized without any long-term problems.

Large local reactions have been reported, especially after Moderna vaccines, including:

  • Itching, redness, and swallowing are not uncommon. This comes on late (>5 days from vaccination) and can last for weeks. Treatment is symptomatic: antihistamine, NSAIDs (like ibuprofen)/Tylenol, ice. You CAN still get the second dose! In the Moderna vaccine trial, delayed large locals like these occurred 4 times less with the 2nd dose than the 1st dose.
  • Consider switching to the other arm for the second dose if you had a local reaction to the first dose.
  • These large local rxns are all very delayed in onset (often after day 8) so mechanistically they are different from immediate reactions.

 

I’ve heard that the vaccines are made from fetal tissue. Is this true?

NO, the Pfizer and Moderna vaccines are synthetic- made from chemicals. The AstraZeneca (AZ) vaccine (not approved as of 1/25/21) does use an immortalized cell line (HEK 293) derived from an abortive fetus from the 1960s for vaccine production. Here is a commentary that discusses this.

 

Where can I get information on how to get the Covid vaccination?

 

How do the Covid vaccines work?

COVID-19 vaccines help boost the immune system against the pandemic-causing SARS-CoV-2 virus. As of 1/25/21, two COVID-19 vaccines are available in the U.S. One by Pfizer/BioNTech and the other by Moderna.  Both of these utilize messenger RNA (mRNA) to make the spike protein found in the SARS-CoV-2 virus, which attaches to human cells leading to infection. The spike protein stimulates the immune system to make antibodies against this virus, making a person less susceptible to contracting it. Having antibodies against the spike protein can prevent the virus from attaching and infecting human cells.  Both vaccines require two doses, three or four weeks apart in order to achieve an optimal immune response.

 

Are there any safety concerns with the new technologies (mRNA and nanotechnology) being used in the development of COVID-19 vaccines?

There are no known additional risks of mRNA vaccines or lipid nanoparticles. Live attenuated viral vaccines, such as the measles vaccine, induce an immune response that is similar to natural infection. mRNA vaccines, on the other hand, simply give the body instructions to produce one very specific part of a virus – in this case the spike protein – to then induce an immune response.  Because mRNA is broken down very quickly in the human body, it is wrapped in a lipid nanoparticle to be able to get into our cells to do its work. Once it gets into the cells to deliver the instructions, the mRNA breaks down very quickly. There are rumors that mRNA vaccines will alter DNA because the RNA molecule can convert information stored in DNA into proteins. That is not true. It is important to note that the mRNA vaccines never enter the nucleus of the cell, where DNA is stored. After injection, the mRNA from the vaccine is released into the cytoplasm of the cells. Once the viral protein is made and on the surface of the cell, mRNA is broken down and the body permanently gets rid of it, making it impossible to change DNA.

This is a nice set of tweets from Andrew Nowalk, MD, Ph.D., a pediatric infectious disease specialist in Pittsburgh. He presents some information on the vaccines that may alleviate some concerns people have about the speed at which the vaccines were developed. They are presented below (but here is a link to his tweets).

  • This is NOT a vaccine created in 9 months. The origin goes back many years.
  • The first reports of an mRNA vector in a lipid particle used as a transfer vehicle go back to 1989 at the Salk Institute. Vaccines were considered using this in the 1990s. Kariko and Weissman made a big leap forward in 2005.
  • They modified the nucleosides of the mRNA, the building blocks that encode the viral protein so that they would be recognized as host RNA and properly translated.
  • Moderna (ever notice the last 3 letters) started in 2010 to expressly use this technology.
  • The first vaccines of this variety are NOT against #COVID it was MERS and OG SARS. Those trials are more than 3 years old.
  • The real analog here is 2009. That’s when we took the pandemic H1N1 strain and made a vaccine with it in 6 months. That’s a good analogy.
  • When this vaccine technology and development started, REM and Nirvana were the big bands, Clinton was president, and an i-anything from Apple was more than half a decade away.

Risk of Covid vaccine in context by Aaron E. Carrol, M.D., who is a professor of pediatrics at Indiana University.

 

What about Covid-19 vaccination in pregnancy?

Please contact your OBGYN to see what his/her current recommendations are.  Most OBs are recommending it for pregnant and nursing mothers.  The Centers for Disease Control and Prevention (CDC), the American College of Obstetrics and Gynecology (ACOG), and the Society for Maternal-Fetal Medicine agree that the new mRNA COVID-19 vaccines should be offered to pregnant and breastfeeding individuals who are eligible for the vaccine. Here is a piece on the Covid vaccine in pregnancy.

More recently, preliminary findings of a study published in the New England Journal of Medicine on 4/21/21 find COVID-19 mRNA vaccines made by Pfizer and Moderna are safe for pregnant women. A study in JAMA Pediatrics found pregnant women who became infected with the virus were at increased risk for maternal mortality, preeclampsia and preterm birth. Therefore, it is particularly important for those who are pregnant to receive the COVID vaccine, and the CDC now recommends that all pregnant women be vaccinated.

 

What if I have already had COVID, do I still need the vaccine?

Yes, you should still receive the vaccine. Due to the severe health risks associated with COVID-19 and the fact that reinfection with COVID-19 is possible, you should still be vaccinated.

 

How soon after being infected from COVID should I get the vaccine?

 Current CDC guidelines state you can receive the vaccine as soon as you are fully recovered from symptoms and out of the quarantine period.  However, reinfection within 90 days of illness is uncommon, so it may be less critical to get the dose right away.  They can wait until closer to the end of the 90 days if they want.

If you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. 

 

The vaccines are not 100% effective, so why should I take them? 

The mRNA vaccines are nearly 100% effective against severe illness from COVID-19. Of the 32,000 people in the Pfizer trial, only one developed COVID-19 severe enough to require hospitalization. Beyond the 95% prevention of any clinical COVID-19 infection, the 5% that got the illness had a very minimal illness. So these vaccines are almost totally effective in preventing COVID-19 illness in all qualifying age groups.

 

If I can still spread the disease after I’ve received the vaccines, why should I take them? 

Disease spread was not a specific endpoint in the clinical trials, but if the clinical illness is reduced by 95%, the spread of the virus should also be reduced by 95%. In the Moderna trial, the asymptomatic disease appeared to be as reduced as significantly as symptomatic diseases.

 

Will the vaccines protect me against the new variants of Covid?

The current data suggest that the vaccines offer varying amounts of protection against the known mutant strains of Covid. While the protection may not reach 95%, it is still very significant.

 

There are (or will be) different Covid vaccines approved. Which one should I get?

The simplest answer is take whatever vaccine you can get as soon as you can get it since all of the approved (or likely to be approved) vaccines essentially eliminate the risk of a severe Covid infection that will lead to death.

 

Does the vaccine contain toxic chemicals that will make me sterile?

NO! There are no toxic chemicals in the vaccine. The lipid component is in many foods and cosmetics. The amount of this material you are exposed to every day is hundreds of times more than in the vaccine. All these substances have been shown to be safe in large studies because they are in food and cosmetics. Therefore, it is unlikely that anything in the vaccine would cause a toxic effect.

There are many false rumors about the Covid vaccines, specifically targeting women. Some of them are debunked here.

 

The information above was compiled from different sources, including:

Here are more links to frequently asked questions: 

Seasonal and Year-Round Allergies (Allergic Rhinoconjunctivitis)

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Outdoor Allergens 

Seasonal allergic rhinitis, commonly referred to as hay fever, affects millions of people worldwide. Symptoms include sneezing, nasal congestion, runny nose, and itchiness in your nose, the roof of your mouth, throat, eyes, or ears. The most common seasonal triggers are pollen and mold spores in the air, which trigger a chain reaction in your immune system.

Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, the immune system identifies pollen as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction.

Pollen

Pollen consists of tiny grains needed to fertilize many kinds of plants. Pollen from plants with colorful flowers, like roses, usually do not cause allergies. These plants rely on insects to transport the pollen for fertilization. On the other hand, many plants have flowers that produce powdery pollen that is easily spread by wind. These culprits cause allergy symptoms.

Each plant has a period of pollination that does not vary much from year to year. Trees pollinate in the spring, grasses in the early summer, and weeds in the late summer/fall. In the St. Louis area, major trees causing symptoms in the spring are oak, ash, and mulberry. Ragweed is a major fall allergen, which typically causes symptoms around Labor Day. The weather can affect the amount of pollen in the air at any time. In warmer places, pollination can be year-round.

Molds

Molds are tiny fungi related to mushrooms but without stems, roots or leaves. Molds can be almost anywhere, including soil, plants, and rotting wood. Their spores float in the air, much like pollen. Outdoor mold spores begin to increase as temperatures rise in the spring. In the United States, mold spores reach their peak in July in warmer states and October in the colder states. They can be found year-round in the South and on the West Coast.

Pollen and Mold Levels

Pollen and mold count measures the number of allergens present in the air. The National Allergy Bureau is the nation’s only pollen and mold counting network certified by the American Academy of Allergy, Asthma & Immunology (AAAAI). The NAB compiles pollen and mold levels from certified stations across the nation. You can find these counts for different geographic areas here. Counts for St. Louis can be found at the St. Louis County Pollen and Mold Center.

Effects of Weather and Location

The severity of your symptoms may be affected by recent contact with other allergens, the amount of pollen exposure, and your sensitivity to pollen and mold. Hay fever symptoms are often less prominent on rainy, cloudy, or windless days because pollen does not move around during these conditions. Pollen tends to travel more with hot, dry, and windy weather, which can increase your allergy symptoms.

Treatment

If your seasonal symptoms are making you miserable, we can help!

As board-certified allergists, we have the background and experience to determine which allergens, if any, are causing your symptoms. This information will form the basis of a personalized treatment plan to help alleviate your symptoms, including recommendations on how to avoid or minimize contact with your allergens where possible.

If your symptoms continue or if you have them for many months of the year, you may benefit from allergy immunotherapy (allergy shots). This treatment involves receiving regular injections given in gradually increasing doses. This helps your immune system become more resistant to the specific allergen and lessen your symptoms as well as the need for medications.

There are also simple steps you can take to limit your exposure to the pollen or molds that cause your symptoms:

Tips

  • Keep your windows closed at night and if possible, use air conditioning, which cleans, cools, and dries the air.
  • Try to stay indoors when the pollen or mold counts are high. If your symptoms are severe, wear a pollen mask if long periods of exposure are unavoidable. When you return indoors, take a shower, shampoo your hair and change clothes.
  • Avoid being responsible for mowing lawns or raking leaves. This stirs up pollen and molds. Also, avoid hanging sheets or clothes outside to dry.
  • When traveling by car, keep your windows closed.
  • Take any medications as prescribed.
  • Avoiding exposure during times of high pollen and mold counts will help ease symptoms.
  • The majority of hay fever medications work best if started before a pollen season begins. For spring allergies, we typically recommend starting medications around Valentine’s Day.
  • Allergy shots can often provide long-term relief of hay fever symptoms.

Source: aaaai.org/conditions-and-treatments/library/allergy-library/outdoor-allergens

 

Indoor Allergens

Millions of people suffer year-round from allergy symptoms caused by indoor allergens. These culprits include dust mite droppings, animal dander, cockroach droppings, and molds.

When allergy symptoms occur year-round, the condition is called perennial allergic rhinitis. In addition to causing allergy symptoms, allergens can also trigger asthma flare-ups in people with allergic asthma.

Dust mites

Dust mite allergens are a common trigger of allergy and asthma symptoms. While they can be found throughout the house, these microscopic creatures thrive in warm, humid environments such as bedding, upholstered furniture, and carpeting.

Because so much time is spent in the bedroom, it is essential to reduce mite levels there. Encase mattresses, box springs, and pillows in special allergen-proof fabric covers or airtight, zippered plastic covers. Bedding should be washed weekly in hot water (130° F) and dried in a hot dryer. Allergen-proof covers are available for comforters and pillows that can’t be regularly washed.

Keep humidity low by using a dehumidifier or air conditioning. Wall-to-wall carpeting should be removed as much as possible. Instead, throw rugs may be used if they are regularly washed or dry cleaned.

Pet Allergens

There are no truly “hypoallergenic” breeds of dogs or cats. That is because people are not allergic to an animal’s hair, but to an allergen found in the saliva, dander (dead skin flakes), or urine of an animal with fur. While there are no cats and dogs that do not produce allergens, the amount of allergen exposure from pets may vary somewhat depending on the breed.

Pet allergy symptoms typically occur within minutes, with short-term exposure. With more chronic exposure symptoms may occur more chronically and not as acutely. For some people, symptoms build and become most severe 8 to 12 hours after contact with the animal. People with severe allergies can experience reactions in public places if dander has been transported on pet owner’s clothing.

If you have a pet that you are allergic to, try to minimize contact and keep the pet out of the bedroom and other rooms where you spend a great deal of time. As with dust mites, vacuum carpets often or replace carpet with a hardwood floor, tile, or linoleum. Keeping an animal outdoors is only a partial solution since homes with pets in the yard still have higher concentrations of animal allergens. If you have a cat allergy, there is a specific cat food that can decrease to some extent the amount of allergen produced by cats. You can read about that here Pro Plan LiveClear Allergen Reducing Cat Food.

While dander and saliva are the sources of cat and dog allergens, urine is the source of allergens from rabbits, hamsters, mice, and guinea pigs; so ask a non-allergic family member to clean the animal’s cage.

If you have a pet allergy, allergy immunotherapy (allergy shots) could be a great option! This strategy can often provide significant and long-term relief.

Cockroaches

Cockroaches are often found in the homes of densely populated urban areas, schools, or commercial buildings, but these creatures can lurk almost anywhere. This does not mean that you have a dirty house or living area.

Block all areas where roaches can enter the home. This includes crevices, wall cracks, and windows. Cockroaches need water to survive, so fix and seal all leaky faucets and pipes. Have an exterminator go through the house when your family and pets are gone to eliminate any remaining roaches.

Keep food in lidded containers and put pet food dishes away after your pets are done eating. Vacuum and sweep the floor after meals, and take out garbage and recyclables. Use lidded garbage containers in the kitchen. Wash dishes immediately after use and clean under stoves, refrigerators, or toasters where crumbs can accumulate. Wipe off the stove and other kitchen surfaces and cupboards regularly.

Indoor Molds

Indoor molds and mildew need dampness typically found in basements, bathrooms, or anywhere with leaks. Get rid of mold growth on hard surfaces with water, detergent and, if necessary, 5% bleach (do not mix with other cleaners). Then dry the area completely. If mold covers an area of more than 10 square feet, consider hiring an indoor environmental professional. For clothing, washing with soap and water is best. If moldy items cannot be cleaned and dried, throw them away.

Repair and seal leaking roofs or pipes. Using dehumidifiers in damp basements may be helpful, but empty the water and clean units regularly to prevent mildew from forming. All rooms, especially basements, bathrooms, and kitchens, require ventilation and cleaning to deter mold and mildew growth. Avoid carpeting on concrete or damp floors, and storing items in damp areas.

Source: aaaai.org/conditions-and-treatments/library/allergy-library/indoor-allergens

Welcome patients of Dr. Esswein to Allergy, Asthma & Food Allergy Centers!

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Dear Dr. Esswein Patients,

We are delighted to welcome you to our practice! While we did not anticipate this particularly trying time, we aim to make your transition as smooth as possible. 

If you are on allergy injections, we should now have your vials. Once we have entered your vials into our electronic system and have you registered in the practice, we will call to let you know that you can come for your injections.  Please wait for this call before you come to our office, but in the meantime, please download the new patient paperwork from this page and allergy shot treatment consent and financial consent. Email the completed new patient paperwork, consent forms, copies of the front and back of your insurance card, and driver’s license to info@aascare.com. Please include in the subject line “transferring Dr. Esswein patient”. If you have not received a phone call in the next 1-2 weeks, please call us. Please also schedule a telemedicine visit at your earliest convenience in order to become further established in our practice. You will need to have that visit before we can refill medications and answer medical questions. The first telemedicine visit will be with Dr. Esswein or one of our advanced practice providers (Lauren Davis, PA-C, Laura Kahle, PA-C, or Dani Loftus FNP-BC) so we can get you established as soon as possible. You can read more about telemedicine visits here.

  • Allergy injections are administered:
    •  8:30AM – 4:30PM Mon-Thur
    •  8:30AM – 2:30PM Fri
    • You will notice we have shot hours on Tue evenings (not currently offered during the COVID-19 pandemic) and Sat mornings. We ask that you kindly avoid these times until further notice, as they are typically our busiest times with the longest wait periods. 
  • We follow the guidelines from our professional allergy societies  that all allergy injection patients will need to wait in the office for 30 minutes after their injections.
  • During this time of concern for COVID-19, we will not escalate your dose. This is to help minimize the risk of an adverse reaction, particularly as we are now in the spring season. We will also allow you an extra week “grace period” where you will not be considered late. 

If you are on a biologic for asthma or hives (ex. Xolair, Fasenra, Nucala, Cinqair, or Dupixent), please call to schedule a telemedicine visit at your earliest convenience. This will allow us to get you registered in the practice and enable us to go through the necessary prior authorization process to obtain your medications. When you are due for your injection(s), and we have verified that we have your medication, we will schedule an in person visit in the office. Please note that our policy is that you will need an office visit for each biologic injection administered in the office. New Patient paperwork is available on this page and information on telemedicine visits is available here. Email the completed new patient paperwork, consent forms, copies of the front and back of your insurance card, and driver’s license to info@aascare.com. Please include in the subject line “transferring Dr. Esswein patient”.

For all other patients, we request that you please schedule a telemedicine visit at your earliest convenience to become established in our practice. We will need to see you for the telemedicine visit in order to refill medications or answer any medical questions. This is also an excellent time to do an annual visit. We can provide updated food allergy and asthma action plans at the time of the visit if needed. New Patient paperwork is available on this page and information on telemedicine visits is available here. Email the completed new patient paperwork, consent forms, copies of the front and back of your insurance card, and driver’s license to info@aascare.com. Please include in the subject line “transferring Dr. Esswein patient”.

We recommend that you follow us on Facebook. We will be posting practice updates, particularly as we do our best to navigate the challenges posed by COVID-19. 

It is our pleasure to play a role in keeping you well. We look forward to meeting you!

Telemedicine Services Available!

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Allergy, Asthma & Food Allergy Centers has been using the doxy.me platform for telemedicine visits since Thursday, March 19, 2020, and this has been working very well for patients at all of our current locations (Swansea, Illinois; Bloomsdale/Ste. Genevieve, Missouri, and south county). Telemdicine appointments can also be done for those currently scheduled to be seen in our Chesterfield (west county) location at 16216 Baxter Rd. Suite 299, Chesterfield, MO 63017. As you know, we have moved most of our patients to telemedicine visits in the interest of public safety to decrease the spread of COVID-19 in our community while continuing to provide essential medical care.

If you are scheduled for any upcoming office visits, other than for biologic medication administration, our staff will continue to contact you before your appointment to convert your appointment to a telemedicine visit. The telemedicine visits enable new and established patients to keep their originally scheduled visits to discuss medical problems, treatment plans, allergy shots, and prescription medications while following the “stay at home” rules. These visits will be increasingly important for patients and families as the spring tree pollen season ramps up. The spring pollen season gets busy, and appointments can be scarce in the greater St. Louis area, but Allergy, Asthma & Food Allergy Centers has 8 active providers who are able to see patients via telemedicine even during these troubled times. Call 314-849-8700 or 618-233-8700 to schedule your telemedicine visit to help you stay healthy during this allergy season.

Telemedicine Frequently Asked Questions:

  1. How does telemedicine work?
    1. A staff member will call you in the morning on the day of your scheduled appointment to collect insurance information and copays.
    2. You will receive a text in most cases (an email if you cannot receive texts or prefer to do the visit using a computer/laptop/tablet) with a link from doxy.me. You can watch a brief instructional video here and/or review this document.
    3. Open the link through your phone or use Chrome browser when on a computer/laptop. You will need a strong internet connection and will need to give permission for the website to use your camera and microphone.
    4. Sign in with the patient’s first and last name and click the “Check In” box, which will place you in the virtual waiting room. You can also review the telemedicine consent and test your connection while in the waiting room.
    5. Once the visit has started, your provider will be able to see you, and you will be able to see them. Your provider may not always be looking at the camera, because they will have another screen open with your medical record so they can document and review your information. Please be assured that if the provider looks away, they are not being distracted from the visit, and your medical care is their sole focus during your appointment.
  2. Do I need to download any program or application?
    1. No, because the doxy.me platform is web-based, you can access it from a browser on an internet connected device.
  3. What type of device do I need?
    1. You need an internet connected smartphone, tablet, computer, or laptop that has a camera and microphone. You will have to give the camera and microphone permission to access your web browser, which you should be able to do in the settings of your device, and we recommend you confirm this before your appointment.
  4. What else should I do to prepare for the visit?
    1. If you have a thermometer, please take your temperature before the visit to let the provider know so they can document it in your chart.
    2. Please take your pulse manually (instructions here) or with an apple watch, fitbit, or other device before the visit and let your provider know so they can document it in your chart.
    3. You can also review the telemedicine consent form here.
  5. Is the telemedicine visit secure?
    1. Yes, the doxy.me telemedicine platform is secure and HIPAA compliant. 
  6. What if I do not receive a text or an email?
    1. If it is 5 minutes past your scheduled appointment and you have not received a text or email, please call our office.
  7. Is telemedicine more expensive than an office visit?
    1. No, you will have the same copay as you would with an in person office visit, but you do not have to leave the comfort of your home.
  8. I have read that insurance companies are waiving copays for telemedicine visits, so why do I have a copay?
    1. Insurance policies vary on this. If your insurance pays for the telemedicine visit, including the cost of the copay, you will receive a refund. You should be able to determine this by the explanation of benefits (EOB) that you will eventually receive from your insurance company.
  9. What if my primary allergist is not available for a telemedicine visit?
    1. Do not worry! Our fantastic advanced practice providers, Lauren Davis, PA-C, Laura Kahle, PA-C, or Dani Loftus, FNP-BC can see you if your primary allergist is not available.

Allergy, Asthma & Food Allergy Centers Telemedicine COVID-19 update 3/20/20

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Dear Allergy, Asthma & Food Allergy Centers Patients and Families,

As we informed you a couple of days ago, our professional societies released COVID-19 Pandemic Contingency Planning for Allergy and Immunology on Tuesday, March 17, 2020. We implemented the guidelines in order to continue providing essential medical care for our patients while keeping our community safe. Social distancing remains one of the centerpieces of prevention, and we are minimizing the amount of time patients may have to spend outside the home. We have updated the information regarding telemedicine visits from the blog posted on Wednesday March 18, 2020. 

  1. Anyone who is currently scheduled for a new patient office visit or a follow up office visit through April 3, 2020, will have the option of converting the in person office visit to a telemedicine visit or rescheduling the in person visit to a later date. The telemedicine platform we are using is https://doxy.me/. You do not have to sign up for an account. You will receive a link to the virtual appointment via text message or email, which you should access through your mobile phone, tablet, or a computer with a video camera and microphone.  Starting on Saturday, March 21, 2020, the telemedicine visits will be billed to your insurance carrier and appropriate copays (depending on your insurance) will be collected over the phone. We will also read you a verbal consent form, which you can review here (informed consent).
  2. If you are on biologic injections (ex. Xolair, Nucala, Fasensra), you should keep your appointment as long as you are not acutely ill with any symptoms suggestive of an infection. However, there may be issues with delivery of the biologic medications, so please confirm with our office on the morning of your appointment to make sure we have received the shipment of the medication.
  3. If you are on allergy shots and have an annual visit coming up at which time you planned on receiving your allergy shots, you can keep that in person office visit.
  4. Patients currently on allergy shots may also continue to receive their injections in our office. However, if you have been building up once weekly, you may start coming every 2 weeks for your buildup phase during this time period. If you are currently on maintenance dosing receiving injections every 2 or every 3 weeks, you may increase your interval to every 4 weeks.
  5. If you are having acute environmental allergy or asthma symptoms, please contact the office to schedule an acute telemedicine visit with one of our providers.
  6. Office based food challenges, oral immunotherapy (OIT) new starts, and OIT dose escalations will need to be rescheduled. Our staff will be contacting families regarding this, so there is no need to call our office. However, if you need more capsules, please make sure to inform the staff member who calls.
  7. If you are ill with fever, cough, and shortness of breath, have any possible COVID-19 exposures, or have traveled (domestic or international) in the past 2 weeks,  please do not come to the office. If you suspect you need testing, please check with the following screening resources:
    1. MO hotline:  877.435.8411
    2. IL hotline:  800.889.3931
    3. Mercy screening:  314.251.0500
    4. SSM Virtual screening:  www.ssmhealth.com

 

For more information regarding COVID-19, please see the CDC website: http://bit.ly/CDC-COVID-19_info 

While COVID-19 is appropriately on all of our minds, allergy season is also upon us. If you have not already started your seasonal allergy medications, you should do so ASAP. In addition, remember to follow routine environmental controls:

  • Keep doors and windows closed in your home to prevent pollen from coming inside.
  • Keep sunroofs and windows on vehicles closed and use recirculation mode for the vehicle’s air conditioner.
  • Bathe or shower and change your clothes after spending time outside during the spring pollen allergy season, because pollen can settle into your clothing and hair. This will also decrease the spread of pollen throughout the home.

We will continue to post updates on Facebook in this evolving situation. Stay safe and healthy.